'Refugees in the USA': Transgender care bans cause families to pull up stakes

People marching in a Pride parade
Over a dozen states and the District of Columbia have passed shield laws that provide legal protections for people traveling for gender-affirming care and those who provide it.
Angela Weiss | AFP via Getty Images 2014

This story comes to you in partnership with KUER’s reporter Saige Miller. The following story discusses suicide and youth mental health that some readers may find triggering. If you or someone you know is in crisis or thinking about suicide, call or text 988 to reach the Suicide and Crisis Lifeline.

Sitting in a nearly empty two-story suburban Utah house, Jen recounted one of her favorite annual traditions. Every year over Mother’s Day weekend, Jen and her family take a trip to the home improvement store. They buy seeds and plants for the garden in the backyard of their suburban Utah home. 

This year was different.

“I was buying moving boxes at Lowe’s to pack up our stuff and when I saw the plants, I just sat in the parking lot and cried,” Jen said. “Because it was the perfect illustration of how our lives had been turned upside down by someone who can flippantly say, ‘We’ll just let the courts decide.’”

Utah was the first state this year to adopt a ban on some gender-affirming care for transgender youth. Under the bill, young people couldn’t receive hormone therapy or undergo procedures such as top-surgery (also known as a full mastectomy) until they turned 18. 

Republican Gov. Spencer Cox signed the bill into law days after the GOP-controlled Legislature gave it the green light. In a statement, Cox thanked the sponsor, state Sen. Mike Kennedy, for his “thoughtful approach to this terribly divisive issue.”

But the law was the last straw for Jen and her family. Jen’s youngest child, Kat, is transgender. Their family felt forced to leave the state they love — and the only place Kat has ever called home.

KUER and MPR News are only using first names in this story due to the family’s safety concerns. 

Fourteen-year-old Kat said they’ve faced immense backlash since coming out as trans, including people using their dead name — the name given at birth with which they no longer use. 

“I mean, especially my school, I’ve been constantly harassed and actually bullied out of the school for about a month, I had to stay home and I get shivers of even thinking of going to school,” they said. “I’ve been misgendered, teased with my dead name, just constant, constant disrespect.”

A person holds a stuffed animal up to their face
Kat, 14, holds their stuffed bunny named Nyx (donning transgender pride flag colors) over their face at their old home in Utah.
Saige Miller | KUER

Kat said the harassment and bullying got worse after the Utah Legislature restricted access to care for trans youth. They were scrolling through Twitter, going down a Sherlock Holmes rabbit hole, when the news that the bill was signed into law popped up on their timeline. 

“I just remembered I just felt like I blacked out. And then I woke up hours later with just a tear-soaked pillow,” Kat said.

The family was unable to sleep for days afterward. Jen’s mental and physical health started to decline. She went to the dentist for tooth pain and discovered the stress from navigating the new law, along with the impacts it was having on her family, “bruised the ligaments of all of my teeth to where every single tooth moves,” Jen said. 

“I’ve always said, like, living here in Utah, I feel like a salmon trying to swim upstream. And I’m really tired. My fins are very worn,” Jen added. “People don’t understand how much this is affecting quality of life for our community and us as individuals and as a family.”

Kat went from the honor roll to 20-plus absences in school. All of these circumstances, Jen said, left them with no option but to leave Utah. 

“They have forced this choice on me. It’s not even a choice,” Jen said. “How can I possibly stay and let my child be treated like this? Let Kat be treated this way? Like I would be a horrible parent if I didn't use the resources that I can gather to get out.”

A sign rests on a couch
A sign in Kat's home reads, "Hey! Governors, Leave THEM Kids Alone!"
Saige Miller | KUER

GOP-led states rush to pass care bans

Utah is among 20 states to enact a ban on gender-affirming care for minors.

Around the country, GOP-led legislatures have enshrined restrictions in the name of protecting children. In Utah, Kennedy — who is also a medical doctor by day — cited a lack of evidence around the impacts of gender-affirming care on minors and questioned whether minors could consent to such procedures. But on the Senate floor, he also questioned whether the bill meets legal muster.

“I’ve tried, along with others, to do my best in this area,” Kennedy said. “And I would bet every dollar in my bank account right now that this will be litigated.”

No lawsuit has been filed challenging Utah’s ban on trans-youth care. The ACLU of Utah confirmed one is in the works. 

Major medical organizations and LGBTQ+ advocacy groups point to data suggesting that rather than protecting children, restrictions on gender affirming-care lead to worse mental and physical health outcomes.

“Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people,” said Dr. Michael Suk, of the American Medical Association.

Alicia Kozlowski speaks during a Trans Day of Visibility rally
Rep. Alicia Kozlowski speaks during a Trans Day of Visibility rally at the Minnesota State Capitol building on March 31.
Nicole Neri for MPR News

Meanwhile, 13 other states and the District of Columbia have passed shield laws that provide legal protections for people traveling for gender-affirming care and those who provide it. Doctors in those states have said they’ve experienced a surge in demand as patients seek care where it’s offered and guarded by law.

Jen’s family looked to those states as a safe haven. While Kat wasn’t receiving gender-affirming care in Utah quite yet, Jen wanted them to have the choice — and that choice is no longer a reality in the state. So Kat’s dad started looking for jobs in Washington state and Minnesota. 

“They deserve to have that option if that is what is going to help them feel safe in their body and affirm who they are,” Jen said.

But there were concerns about moving to Minnesota. Since it’s a politically purple state, the family worried Republicans in Minnesota would reverse gender-affirming care protections if they ever regained power. 

They ultimately settled on Washington. They put their Utah house on the market, purchased a house in the Pacific Northwest and in just a blink of an eye, they were waving goodbye to the home Kat was raised in.

No one took the move easily, but it hit Kat the hardest. 

“It’s just the only place I ever knew,” they said. “It was where all my friends are, and knowing that I’m going to have to go to 10th grade — probably one of the craziest grades to move states from because everyone already has their little cliques — it’s just going to be vile.”

Bella Mendez, 8, stands with her mother during
Bella Mendez, 8, stands with her mother during a Trans Day of Visibility rally at the Minnesota State Capitol building on March 31.
Nicole Neri for MPR News

Minnesota sees patient surge

Minnesota is one of the states to adopt legal protections for gender care this year. And physicians say it has been a whirlwind. Calls from patients from other states have surged as lawmakers limit access to legal care options there.

“It is really strange that it’s 2023. And we’re making refugees within the United States of America,” said Dr. Kelsey Leonardsmith, a physician who provides hormone care in the Twin Cities.

At the Minneapolis clinic where Leonardsmith sees patients, out-of-state patient calls used to be relatively rare. Now they get several each week.

“They are really concerned about losing access to their medical care,” Leonardsmith said. “The climate of what it’s like to just try to experience the health care system and try to access gender affirming care in hostile places that are passing hostile legislation is really challenging and maybe unsafe.”

While hospitals and clinics have trained more providers to offer gender-affirming care services, they’re still having trouble keeping up, she said. 

“You run a real risk of, like, doing wrong by trying to do right, trying too hard to take care of everybody so that you’re not doing a good enough job,” Leonardsmith said. “Nobody wants to see that.”

Children's Hospital
The exterior of Children's Hospitals and Clinics of Minnesota is seen in St. Paul.
Yi-Chin Lee | MPR News 2014

Dr. Katy Miller works at Children’s Minnesota’s gender health program. She said patient requests have surged 40 percent since other states began enacting bans. And while the hospital is working with other clinics, it has a one-year wait list for gender-affirming care.

“We are hearing from people all over the country, we’ve had families call from Florida from Texas, Iowa — a lot from Iowa — North Dakota, we’ve had patients, literally from all over the country,” Miller said. 

As other states had to shut down gender care units, states like Minnesota — where lawmakers have issued protections for patients seeking gender-affirming care and those who provide it — have had to increase capacity.

Miller said patients traveling to Minnesota have a lot on their minds.

“I think another challenge is that people feel very afraid of what might happen next, people feel victimized by the government. It’s led to a distinct degree of fear and anxiety about accessing medical care that I haven’t seen before,” Miller said.

Both Miller and Leonardsmith say their out-of-state patients are turning to Minnesota as they feel they’re becoming political refugees. They’ve tried to get their documents in order in case they have to flee the states where they live.

“We’ll hear from Holocaust survivors saying, ‘Carry your passport all the time,’ you know, or folks who I know bought a new car because they wanted to make sure that if they needed to drive to Canada, their car wouldn’t break down,” Leonardsmith said.

Miller said she feels like she’s working under a microscope. If she gets something wrong, it could become a political talking point.

But her more pressing concern is keeping her patients alive.

“My biggest fear is that one of my patients will commit suicide. And that’s, that’s really pervasive, it’s gotten worse,” Miller said. “We know that these laws and these bans impact the mental health of gender diverse youth. We know that trans and gender-diverse youth are at much higher risk of suicide.”

A young girl holds hands with the governor after a bill is signed
Gov. Tim Walz shakes hands with 12-year-old Hildie Edwards, a transgender girl who testified in support of the trans refuge bill in February, after it is signed into law at the Minnesota State Capitol in St. Paul on March 8.
Ben Hovland | MPR News

The political push to pass and keep protections

Minnesota lawmakers cited concerns about the impact that bans elsewhere had on trans youth when they passed legal protections this year. Minnesota for the first time this year had lawmakers who were openly trans and nonbinary, as well as a formal Queer Caucus. 

Democrats along with LGBTQ+ groups say they hope to market Minnesota as a refuge state for transgender people and their families and serve as a national model.

“Sometimes we’re too humble about our wins here,” Kat Rohn, executive director of OutFront Minnesota, said. “This is one that we should all celebrate about creating a state that’s more inclusive, that’s bringing hope to people, that’s creating space when it’s needed most at a time when our communities are under attack.”

While Minnesota has Democratic control now, LGBTQ+ groups like Rohn’s said they have to keep working to solidify access to health care in case the power structure changes in the future.

“There's work to do tomorrow. And folks in Minnesota still have a lot of things that we need to accomplish to make the state fully equitable for LGBTQ folks,” Rohn said.

Democratic leaders have said they’re weighing a constitutional amendment that would guarantee equal rights regardless of a person’s gender identity, expression or sexual orientation. If approved in the Legislature, it would come before voters to decide in 2024. 

The bill’s authors said the language could offer extra protection for LGBTQ+ Minnesotans in the future and they hope voters will agree with them. 

But — at least for now — gender-affirming care is protected in Minnesota.

A mother and daughter smile during a press conference
Gretchen Nguyen holds her daughter, 6-year-old Asher Nugyen, during the signing ceremony for the trans refuge bill at the Minnesota State Capitol in St. Paul on March 8.
Ben Hovland | MPR News

Life in Washington 

Jen and Kat’s family are adjusting to their new normal. 

Kat is still “pretty pissed” about leaving Utah — they miss their friends and the memories they made back in the desert West. While the transition has been tough, Kat appreciates that they “haven’t had anyone be outwardly transphobic toward me.”

They’re anxious about starting a new school, too. They’re considering joining theater once school is back in session along with a creative writing and Dungeons and Dragons club if it’s offered. 

Moving boxes rest against a wall
Kat’s backpack rests near a small stack of moving boxes. The family made the tough decision to leave Utah for Washington State following a recent state law that prohibits transgender minors from accessing some gender-affirming care services.
Saige Miller | KUER

For Jen, it feels like a massive weight has been lifted off her shoulders. She said the people in the Evergreen State have been welcoming and she’s “cried endless tears of happy relief” since the move. 

Although, she misses the scent of the sage that used to grow in her garden back in Utah. 

“I wish I would have known the last time I stargazed with the hot summer breeze and sweet smell of sage so I could have cherished it a little longer,” Jen said. “That being said, I’m resolved to enjoy every new memory made getting to know this place.” 

A person bends down in their yard
Kat, 14, looks at the trees planted in the backyard of their old home in Utah. Their family moved to Washington State after Utah enacted a ban on gender-affirming care for transgender youth.
Saige Miller | KUER